Impact of Dialysis on the Prognosis of Patients Undergoing Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology 2019-01, Vol.123 (2), p.315-322
• Main Authors: Schymik, Gerhard, Bramlage, Peter, Herzberger, Valentin, Bergmann, Jens, Conzelmann, Lars Oliver, Würth, Alexander, Luik, Armin, Schröfel, Holger, Tzamalis, Panagiotis
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Aortic valve; Bleeding; Calcification; Cardiovascular disease; Clinical outcomes; Clinical trials; Complications; Confidence intervals; Consortia; Coronary vessels; Dialysis; End-stage renal disease; Heart attacks; Heart surgery; Hemodialysis; Hypertension; Implantation; Kidney diseases; Life expectancy; Lung diseases; Medical prognosis; Medical research; Mercury; Mortality; Myocardial infarction; Optimization; Patients; Regression analysis; Statistical analysis; Stenosis; Stroke; Transplants & implants
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.10.008

End-stage renal disease (ESRD) affects approximately 2% to 4% of patients with severe aortic stenosis. It is because these patients have been excluded from clinical trials, the impact of transcatheter aortic valve implantation (TAVI) in this patient group has not been thoroughly investigated. Between April 2008 and March 2015, 2,000 patients (dialysis group, n = 56 [2.8%]) were consecutively enrolled when diagnosed with severe aortic stenosis and eligible to undergo TAVI. Procedural and longer-term outcomes were analyzed and adjusted for differences in baseline characteristics. Patients on dialysis had a higher periprocedural mortality (10.7% vs 1.7%; adjusted odds ratio [adjOR] 5.65, 95% confidence interval [CI] 1.91 to 16.67; p = 0.002) and a lower Valve Academic Research Consortium (VARC)-II (VARC) defined device success (adjOR 0.34, 95% CI 0.15 to 0.79; p = 0.012). At 30 days, there was an increased rate of all-cause mortality (21.4 vs 4.8%; adjOR 4.90, 95% CI 1.96 to 12.26; p = 0.001), cardiovascular (adjOR 3.67, 95% CI 1.43 to 9.41; p = 0.007) and noncardiovascular mortality (adjOR 6.28, 95% CI 1.36 to 9.41; p = 0.019), myocardial infarction (adjOR 9.39, 95% CI 1.84 to 48.03; p = 0.007), bleeding (adjOR 2.48, 95% CI 1.06 to 5.83; p = 0.036) as well as the VARC-II defined early safety combined end point (adjOR 2.97, 95% CI 1.28 to 6.90; p = 0.012) associated with dialysis. Dialysis was associated with poor survival at one (57.1% vs 84.2%) and 3 years (26.8% vs 66.9%) with or without the consideration of the first 72 hours (p